The role of sugammadex in the development and modification of an allergic response to rocuronium: evidence from a cutaneous model *

The availability of sugammadex as a selective encapsulating agent for rocuronium has led to speculation that it may be useful in mitigating rocuronium‐induced anaphylaxis. Off‐label use of sugammadex for this indication has already been documented in case reports although there are theoretical objections to the likelihood of an allergen‐binding agent's being able to attenuate the immunological cascade of anaphylaxis. Using a cutaneous model of anaphylaxis in rocuronium‐sensitised patients, we were unable to demonstrate that sugammadex was effective in attenuating the type‐1 hypersensitivity reaction after it has been triggered by rocuronium, but we were able to demonstrate that these patients are anergic to sugammadex‐bound rocuronium. These findings demonstrate that a cyclodextrin can bind an allergen and exclude it from interacting with the immune system, and may potentially lead to novel applications in other allergic diseases. However, there is no evidence that sugammadex should be used for the treatment of rocuronium‐induced anaphylaxis, and clinical management should follow established protocols.